Transcript Biosurveillance

Harmonized
Biosurveillance
Use Case
By
Resty Namata, Maria Metty & Priyaranjan Tokachichu
December 13, 2007
Brief History
1979 - Sverdlovsk, Russia
• Accidental release of anthrax from bio-weapons plant.
• 6 people with flu-like symptoms not treated for anthrax.
• 21 people had died before lab results confirmed anthrax
Following September 11, 2001
• Anthrax release in United States
• Detected early because nation was on heightened alert.
From November 2002 to 31 July 2003
• Severe Acute Respiratory Syndrome in Asia
• WHO estimates up-to 60 % of cases were healthcare
workers
Biosurveillance Use Case
Requirements
Transmit real-time data from healthcare providers to
Public health Agency within 24hr lag
Attributes:
Real-time
• Fulfilled by data transmission from HER
Timeliness
• Define by Michael Wagner et al. as difference
between time of event detection & time event
occurred
Ultimate Goal:
Early detection
•
Need to early detection of natural or man-made
disease outbreak in order to mobilize resources and
minimize morbidity and mortality
Biosurveillance
Use Case context diagram
Transmit
/Receive essential
ambulatory care
Ambulatory Clinician
Hospital
Transmit /Receive
ED visits &
Utilization
Send /Receive
acknowledgement
Public
Healthcare
Agency
Transmit /Receive
essential lab results
Laboratory
Organization
Data is anonymized & aggregated before transmission
from Electronic Medical Record Systems
Case for early detection
Disease Detection
Phase II
1 Phase I
Acute Illness
Initial
0.9
0.8 Symptoms
Traditional Disease
Early Detection
0.7
Detection
0.6
Gain of 2
0.5
days
0.4
0.3
0.2
0.1
0
0
24
48
72
96
Effective
Treatment
Period
120
144
168
Incubation Period (Hours)
• Category A disease agents cause non-specific symptoms like
fever, cough & fatigue
• People don’t seek medical care during effective treatment period.
For example: Consumer Healthcare Products Association survey:
42% of people with “flu” symptoms purchased over-the-counter(OTC)
medication prior seeking medical care.
* Use Case Data is collected after lab results and diagnosis
Proposal
 Collect sales data of over-the-counter healthcare
product such as electrolytes, diarrhea, cough,
thermometer and fever medications from retail
stores and transmit it to public health agency
* It has been correlated with disease outbreak.
* It is routinely collected for supply chain management
* Available from National Retail Data Monitor System
* It is low cost
Modified Biosurveillance
Use Case context diagram
Clinician
Transmit /Receive
essential ambulatory
care
Transmit /Receive ED
visits & Utilization
Hospital
Transmit /Receive
essential lab results
Laboratory
Organization
Retail Store
Send /Receive
acknowledgement
Public
Healthcare
Agency
Transmit Sales
OTC sales data
Data is anonymized &aggregated before transmission
from Electronic Medical Record Systems
OTC-Sales Data
Required
• Universal Product Code
• Purchase Date
• Sales Total
• Product Description
• Category
• Store Identifiers
• Other Information
Stakeholders
• Retails Stores that sell OTC healthcare products
Pre-Conditions
• Procedures and agreements signed for data exchange
Post-Conditions
• Data transmitted to an authorized Public Health agency
• Acknowledgement sent back to sender
Costs
Costs
Costs
Costs
Costs
Impact
Patient Impact
Physician Impact
Physician Impact
Public Health Impact
Retail Stores Impact
Recommendation
We Recommend adding this data with reservations
because:
1. It is difficult for public health to understand the data
2. OTC Data is noisy
3. Hard to identify a person who purchased a product.
4. Due to competitive agreements the store cannot be
identified either.
Thanks
Dr. Lael Gatewood
Dr. Richard Pham
Mr. Joseph Plasek
Special Thanks to:
Jayne Griffith
Senior Epidemiologist
Bioterrorism Unit
Minnesota Department of Health
651.201.5085
[email protected]
M. Cleat Szczepaniak
Program Manager
National Retail Data Monitor and Pennsylvania RODS
412.648.6728